What TMS costs in Pennsylvania and how insurers approve it

Every major insurer operating in Pennsylvania covers TMS for major depressive disorder, but all of them require documented failure of prior treatment first. Independence Blue Cross in the Philadelphia region, Highmark Blue Cross Blue Shield across western and central Pennsylvania, UPMC Health Plan, Capital Blue Cross, Geisinger Health Plan, Aetna and Cigna typically require trials of two to four antidepressants from more than one class, usually alongside a course of psychotherapy. Medicare covers TMS in Pennsylvania under the local coverage determination administered by Novitas Solutions, the Medicare contractor for Jurisdiction L, which requires trials of four medications or documented intolerance. Coverage under Pennsylvania Medical Assistance and the HealthChoices managed care plans is more limited than commercial coverage and prior authorization is strict — confirm with the clinic before you start. Most Pennsylvania clinics handle the authorization paperwork for you — ask before your consultation.